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Worker forms

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If you have any questions about these forms, or would like help filling them out, please call us at 1-800-387-0750 or 416-344-1000 (TTY: 1-800-387-0050) Monday to Friday, 7:30 a.m. to 5 p.m.

Form Number Form Name
Report An Injury/Illness
0006A

 

Worker's Report of Injury/Disease Form 6

For a faster, more efficient experience, you can complete and submit your Report of Injury/Illness online or call us at 1-800-387-0750 or 416-344-1000 (TTY: 1-800-387-0050) Monday to Friday, 7:30 a.m. to 5 p.m.

If you're under 16 years of age, or are filling out a Report of Injury for someone is under 16, please print a Form 6 pdf (PDF) and fax or mail us your report.

Our Reference Guide for Workers (PDF) will give you more information on filling out this form.

0032A
(PDF) 
Worker's Report Occupational Noise Induced Hearing Loss
3958A
(PDF) 

Worker's Exposure Incident Reporting Form - PEIR

 

3885A (PDF) 

Worker's Exposure Incident Reporting Form - CEIR

 

Claims

New 

2397A (86.0kb, PDF)

Intent to Object form

Read our instructions to workers (PDF) on how to fill out this form.

0806A

(148k, pdf)

WSIB Medication Reimbursement Form
2144A
(PDF) 

Request a copy of your claim form

(Request for Access to Own Personal Information)

2721A
(PDF) 
Worker Travel Expense Form
2719A (PDF) Health Care Travel Expense Form - Occupational Disease and Specialized Services
2996A (PDF)  Work Transition: Worker Travel and Expenses
3072A (PDF)

Spanish (PDF)
Direct Deposit Enrollment form

Solicitud de depósito directo
 
3074A  (PDF) 
Power of Attorney for Property/Guardianship of Property Form
3164A
(PDF) 
General Worker Expense Form
3306A (PDF) 

Complete and submit our clothing allowance form or fill out our online application.

Read more about the clothing allowance benefit.

3585A
(PDF) 
Vision Care Claim Form
Employee Coverage
2929A
(PDF) 
WSIB Policy Manuals Order Form
1824A
(PDF) 

Direction of Authorization

This is not a request for access or an appeals form. It is only used to provide authorization for representation in a claim. Only after this authorization is obtained can a representative be given verbal or written information about the claim or make a request to be provided with copies of claim file documents.

Return to Work and Recovery
0041A
(PDF) 
Worker's Progress Report
2232A
(PDF) 
Worker's Continuity Report (Form REO6)
2647A (PDF) 

Functional Abilities Form for Early and Safe Return to Work version 2006

Guide to Completing the Functional Abilities Form (pdf)

 

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